Family Functioning in OCD Renae M. Reinardy, Psy.D. & Kristin L. Holland, MA, LPC

Therapeutic Advice

What is OCD? DSM-5 Criteria Prevalence Presence of obsessions, compulsions, or both Time consuming, distress, impairment Not due to substances or medical condition Not caused by another disorder Prevalence 1 in 50 adults, 1 in 100 children Females slightly higher as adults, males higher in childhood Fourth most common mental disorder

What are Obsessions & Compulsions? Repetitive Rituals Persistent Repetitive behaviors Thoughts, images, urges Mental acts Not pleasurable Feels driven to perform Involuntary Neutralize Intrusive “Fix” Unwanted Avoidance Cause distress or anxiety Repeat until “just right”

Themes Found in OCD Obsession Compulsion Contamination Washing Checking Cleaning Self-harm Harm to others Excessive reassurance seeking Sexual Avoidance Religious/moral Tapping Just right/Tic-like Praying Perfectionism Confessing Symmetry Rereading Relationship Researching

Treatment of OCD Exposure Response Prevention Stand toe to toe with fear Do the opposite Exposure to triggers Example: client may touch bottom of shoe Response Prevention Resist fix-it behaviors/rituals Do it out of order Less than perfect Example: Client resists washing hands before eating

Treatment of OCD Habituation happens Medications Involving the family Diminished emotional response with repeated exposure Gradual vs. flooding In office vs. In-Vivo Medications Work best if combined with ERP Involving the family How might family involvement impact OCD symptoms and ERP?

Family Accommodation Modification of personal and family routines in response to OCD symptoms Accommodation in OCD is common and is strongly and consistently correlated with overall symptom severity (Lebowitz, E.R., Panza, K.E. & Bloch, M.H., 2012) Case studies Family accommodation in response to contamination fear Family accommodation in response to fear of developing a brain tumor/religious obsessions Take a moment and think about how OCD has impacted your family

Cycle of Accommodation “What if I go to Hell?” Distress Asks mom for reassurance

Cycle of Accommodation Some short-term reduction in distress Long term, obsessions continue (Remember, you can’t rationalize with OCD) Daughter more likely to seek reassurance from mom, chasing the short-term relief

Cycle of Accommodation Over time, mom grows frustrated her words don’t have any long-term impact Frustration often leads to conflict and added stress Added stress often leads to a worsening of OCD symptoms

Assessing Family Accommodation MEASURE : RATED BY: FAS Clinician FAS-IR FAS-PR Parent of child with OCD FAS-SR Relative of patient with OCD FAS-PV Patient with OCD

Family Accommodation Scale for OCD

How do we Guard Against Accommodation? Negotiation & limit setting Preserve individual rights (e.g., can have friends over, sit on any furniture) Preserve individual and family routines (e.g., being on time, minimizing avoidance) Consider family contract - plan ahead; don’t define limits in middle of conflict Gradual process Development of a family response script Supportive/nurturing tone; stay calm & avoid being antagonistic Focus on combating OCD together; avoid personal criticism Keep communication clear and simple; avoid lengthy rationales & debates

From the Human Side

Things to Remember Be realistic Recognize and praise small improvements Self-care is important Avoid day-to-day comparisons Expect occasional setbacks as a normal part of recovery Modify expectations during times of change/stress Be sensitive to mood It’s not all about the OCD

In Conclusion… With ERP, there is great hope! By minimizing family accommodation, family members can help their affected loved one face their fears and combat OCD Family members can serve as a huge source of support and motivation Setting limits & maintaining a supportive environment can aid in relapse prevention Improvement in OCD symptoms positively correlates with family functioning Seek out a family therapist who specializes in OCD and ERP if your family is having difficulty identifying and minimizing accommodating behaviors